Progress In Cartilage Repair: The Holy Grail Of Knee OA

Article preview from Medtech Insight - October 28, 2013

Researchers have been working for years to develop a reliable and cost-effective means of regenerating the hyaline cartilage found in the knee, with the aim of offering a minimally invasive treatment option for the millions of patients with painful knee osteoarthritis. Although this goal has been elusive so far, recent progress suggests the field may have turned a corner, and a large number of companies are now competing to win this quest, which many refer to as the “Holy Grail” of knee OA.

 

Progress In Cartilage Repair: The Holy Grail Of Knee OA

 

Article preview from Medtech Insight - October 28, 2013

Regenerating the hyaline cartilage found in the knee is one of the most elusive and highly sought after goals facing researchers in the orthopedic industry today. Attempts over the last two decades to regenerate “true” hyaline cartilage using both cell-based and, more recently, cell-free approaches have fallen short, and this is not due to lack of trying or investment in this space. However, based on information presented at the International Cartilage Research Society (ICRS) 2013 World Congress, held last month in Izmir, Turkey, it appears that progress in this field has finally turned a corner, and recent strides in basic research are beginning to unravel the potential reparability of the tissue covering the articular surface of joints.

Interest in cartilage regeneration remains high since the general consensus is that an injury to the articular cartilage is the first step in the joint degenerative process. But the reality is that not all cartilage injuries progress to osteoarthritis (OA), although the risk is higher for larger lesions. Another common misconception is that an injury to the articular cartilage always results in pain; however, not all cartilage lesions are painful (cartilage has no neural innervation), nor do all of these lesions need to be treated unless they are symptomatic. Thus, questions arise as to what makes a cartilage lesion painful and what makes a lesion predisposed to OA.

Presentations at the ICRS meeting focused not only on the underlying mechanisms for cartilage regeneration, but also on the role of subchondral bone in articular cartilage repair. The presence of bone bruises or bone marrow edema resulting from a traumatic injury or chronic abnormal joint loading was postulated as a potential source of pain associated with a cartilage injury. In fact, microfracture of the underlying subchondral bone – a common first-line treatment for chondral defects – has been shown to negatively impact certain cartilage repair techniques such as autologous chondrocyte implantation (ACI).

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